Shared Health Record

Shared Health Record (SHR)

Introduction

The Shared Health Record (SHR) is a core component of a Health Information Exchange (HIE) that enables clinical data sharing across different health information systems. By serving as a centralized repository for normalized patient data, the SHR ensures that healthcare providers have access to a consistent and unified health record—regardless of which system originally collected the data.

The SHR facilitates real-time access to patient information, improving care coordination, decision-making, and overall health outcomes. Unlike a data warehouse, which is primarily used for reporting and analytics, the SHR functions as an operational, real-time transactional data source that supports live updates and queries across healthcare systems.

Key Functions of the Shared Health Record

The SHR serves multiple critical functions within a healthcare interoperability framework:

1. Centralized Data Repository

Collects and stores patient health records from various clinical systems (e.g., Electronic Medical Records (EMRs), Laboratory Information Systems (LIS), Radiology Information Systems (RIS)).
Maintains a longitudinal patient record, allowing authorized providers to access comprehensive health history.

2. Real-Time Data Exchange

Supports bi-directional communication, allowing authorized systems to query and update patient records in real time.
Ensures that healthcare providers have timely access to the latest patient information.

3. Data Normalization and Standardization

Converts local identifiers (e.g., patient ID, provider ID, facility ID) into universal identifiers, ensuring data consistency.
Maps terminology codes to standard reference terminologies (e.g., SNOMED CT, LOINC, ICD-10) to enable semantic interoperability.

4. Secure and Controlled Data Access

Implements role-based access control (RBAC) to ensure that only authorized users and systems can read or update patient records.
Supports consent management mechanisms to honor patient privacy preferences and comply with data protection regulations.

5. Improved Clinical Decision Support

Provides a complete and accurate patient record at the point of care, reducing errors caused by incomplete or missing data.
Enables AI-driven clinical decision support systems (CDSS) to leverage comprehensive health data for predictive analytics and treatment recommendations.

How the Shared Health Record Works

1. Data Sources and Contributions

The SHR aggregates data from various healthcare systems, including:
- Electronic Medical Records (EMRs) – Patient visits, diagnoses, prescriptions, allergies, clinical notes.
- Laboratory Information Systems (LIS) – Lab test orders, results, interpretations.
- Radiology Information Systems (RIS) – Imaging studies, radiology reports.
- Pharmacy Information Systems (PIS) – Medication dispensing records.
- Public Health and Surveillance Systems – Immunization records, disease surveillance data.

2. Normalization and Data Standardization

When data is received, the SHR normalizes it by:
- Resolving metadata items (e.g., mapping local patient identifiers to a universal patient ID).
- Ensuring terminology consistency by mapping codes to standard reference terminologies.

For example:
- A patient ID used in Hospital A may differ from the ID used in Hospital B. The SHR links these records to a single universal patient identifier.
- Lab results stored in proprietary codes are converted to LOINC (Logical Observation Identifiers Names and Codes) for uniformity.

3. Data Access and Queries

Authorized systems can send queries to retrieve patient records.
Data retrieval can be patient-specific (e.g., “Fetch John Doe’s last 3 lab results”) or condition-specific (e.g., “Find all hypertensive patients”).

4. Updating the SHR

When a healthcare provider updates a patient’s medical record in their local system, the change is synchronized with the SHR.
The update must comply with data governance policies, ensuring accuracy, completeness, and security.

Distinguishing SHR from a Data Warehouse

Feature	Shared Health Record (SHR)	Data Warehouse
Purpose	Real-time operational data exchange for clinical use.	Historical data analysis and reporting.
Data Type	Transactional data (live updates).	Aggregated data (used for trends and analytics).
Access	Queried and updated by authorized systems in real time.	Used for business intelligence, research, and analytics.
Data Structure	Normalized data, mapped to standard terminologies.	Often denormalized for analytical processing.

Benefits of Implementing a Shared Health Record

1. Enhances Patient-Centered Care

Provides clinicians with a complete view of a patient’s medical history, reducing duplicate tests and conflicting treatments.
Improves continuity of care by allowing seamless information sharing across hospitals, clinics, and laboratories.

2. Reduces Medical Errors and Data Duplication

Minimizes errors due to incomplete or inconsistent patient records.
Eliminates duplicate data entries by maintaining a single source of truth.

3. Strengthens Health System Interoperability

Facilitates seamless data exchange between health information systems.
Enables multi-institutional care coordination and patient referrals.

4. Improves Public Health Surveillance and Research

Provides real-time data access to epidemiologists and public health officials.
Supports disease tracking and outbreak monitoring by aggregating national health data.

5. Enables AI and Data-Driven Decision-Making

Supports machine learning models for predictive analytics.
Enhances clinical decision support systems (CDSS) by integrating diverse health data sources.

Implementation Considerations

1. Data Governance and Quality Control

Establish policies for data accuracy, validation, and deduplication.
Define data stewardship responsibilities to ensure ongoing maintenance.

2. Security and Access Control

Implement strong authentication mechanisms (e.g., OAuth 2.0, JWT tokens).
Ensure compliance with privacy regulations (e.g., GDPR, HIPAA).
Restrict access to authorized healthcare professionals only.

3. Interoperability Standards

Use FHIR (Fast Healthcare Interoperability Resources) for structured health data exchange.
Adopt HL7 messaging standards for system-to-system communication.
Ensure compatibility with SNOMED CT, LOINC, and ICD-10 for standard terminology mapping.

Allow patients to define access preferences for their health data.
Implement audit logs to track data access and modifications.

Conclusion

The Shared Health Record (SHR) is a crucial infrastructure for enabling interoperable, patient-centered healthcare systems. By providing real-time, standardized access to patient data across institutions, the SHR enhances clinical decision-making, reduces medical errors, and improves healthcare coordination.

Shared Health Record